B cells from subjects with CVI can be driven to Ig production in response to CD40 stimulation.

The majority of patients with common variable immunodeficiency (CVI) have low to normal numbers of membrane Ig-bearing B cells; yet these cells fail to differentiate in vivo resulting in hypogammaglobulinemia. We have suggested that the differentiation failure of CVI B cells is related to a failure to respond appropriately to signals involved in terminal B cell differentiation as most CVI subjects' cells undergo activation and proliferation normally. Whether this failure relates to a direct "intrinsic" defect in the B cells or is secondary to a lack of appropriate T cell or other influences in vivo is uncertain. We have previously reported that the majority of patients with CVI have elevated circulating levels of IL-6. We now show that the IL-6 produced by these patients is functionally normal. Additionally, the display of IL-6 receptors on in vitro stimulated CVI B cells is normal. However, we found that the patients' cells do not make IgE in response to an IL-6/T-cell-dependent differentiation pathway employing exogenous interleukin-4 (IL-4). The failure to respond in the IL-6-dependent system could not be overcome by exogenous IL-6 or varying doses of IL-4. In contrast, when stimulated by CD40 plus IL-4 in a differentiation pathway that does not require IL-6, B cells from CVI patients were stimulated to produce IgE. These findings, along with our earlier data showing that 13-cis-retinoic acid can drive maturation in CVI patients, strengthen the concept that B cells in patients with CVI have the potential for terminal differentiation but do not appear to achieve this in vitro or in vivo through a polyclonal Ig differentiation pathway that employs IL-6 as one of its maturation signals.